Bailey Stacy Cooper, Brega Angela G, Crutchfield Trisha M, Elasy Tom, Herr Haley, Kaphingst Kimberly, Karter Andrew J, Moreland-Russell Sarah, Osborn Chandra Y, Pignone Michael, Rothman Russell, Schillinger Dean
Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Dr Bailey)
Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA (Dr Brega)
Diabetes Educ. 2014 Sep-Oct;40(5):581-604. doi: 10.1177/0145721714540220. Epub 2014 Jun 19.
Inadequate literacy is common among patients with diabetes and may lead to adverse outcomes. The authors reviewed the relationship between literacy and health outcomes in patients with diabetes and potential interventions to improve outcomes.
We reviewed 79 articles covering 3 key domains: (1) evaluation of screening tools to identify inadequate literacy and numeracy, (2) the relationships of a range of diabetes-related health outcomes with literacy and numeracy, and (3) interventions to reduce literacy-related differences in health outcomes.
Several screening tools are available to assess patients' print literacy and numeracy skills, some specifically addressing diabetes. Literacy and numeracy are consistently associated with diabetes-related knowledge. Some studies suggest literacy and numeracy are associated with intermediate outcomes, including self-efficacy, communication, and self-care (including adherence), but the relationship between literacy and glycemic control is mixed. Few studies have assessed more distal health outcomes, including diabetes-related complications, health care utilization, safety, or quality of life, but available studies suggest low literacy may be associated with increased risk of complications, including hypoglycemia. Several interventions appear to be effective in improving diabetes-related outcomes regardless of literacy status, but it is unclear if these interventions can reduce literacy-related differences in outcomes.
Low literacy is associated with less diabetes-related knowledge and may be related to other important health outcomes. Further studies are needed to better elucidate pathways by which literacy skills affect health outcomes. Promising interventions are available to improve diabetes outcomes for patients with low literacy; more research is needed to determine their effectiveness outside of research settings.
糖尿病患者中普遍存在读写能力不足的情况，这可能会导致不良后果。作者回顾了糖尿病患者的读写能力与健康结果之间的关系，以及改善结果的潜在干预措施。
我们回顾了79篇涵盖3个关键领域的文章：（1）用于识别读写和计算能力不足的筛查工具的评估；（2）一系列糖尿病相关健康结果与读写和计算能力的关系；（3）减少健康结果中与读写能力相关差异的干预措施。
有几种筛查工具可用于评估患者的印刷读写和计算技能，有些专门针对糖尿病。读写和计算能力始终与糖尿病相关知识相关。一些研究表明，读写和计算能力与中间结果相关，包括自我效能感、沟通和自我护理（包括依从性），但读写能力与血糖控制之间的关系并不一致。很少有研究评估更长期的健康结果，包括糖尿病相关并发症、医疗保健利用、安全性或生活质量，但现有研究表明，低读写能力可能与并发症风险增加有关，包括低血糖。有几种干预措施似乎对改善糖尿病相关结果有效，无论患者的读写能力状况如何，但尚不清楚这些干预措施是否能减少结果中与读写能力相关的差异。
低读写能力与较少的糖尿病相关知识有关，可能与其他重要健康结果也有关。需要进一步研究以更好地阐明读写技能影响健康结果的途径。有一些有前景的干预措施可改善低读写能力患者的糖尿病结果；需要更多研究来确定它们在研究环境之外的有效性。
